Gayle Sweitzer, director of marketing at Community Health Network in Indianapolis, projected that 2,000 locals would attend the grand opening of the organization's new flagship hospital. On the day of the event, 7,000 people turned up.
"It was a Sunday afternoon and it's a hospital building," Sweitzer says. "Everyone always wants to have their baby here, so I was thinking there will probably be a fair number of pregnant moms and we'll get some people out—but it's a Sunday afternoon in April, come on."
The expectation-exceeding event was one of the first indicators of the success of the "Community North Expansion" campaign, which won a gold award in the Best Integrated Campaign category at the 2008 HealthLeaders Media Marketing Awards. Community Health created the campaign to promote its new $180 million facility and because market research showed that Indianapolis consumers had a vanilla feeling about the organization.
Sweitzer and her marketing team worked with Indianapolis advertising firm Meyer & Wallis to create an integrated campaign consisting of print, outdoor, TV, direct mail, radio, and online marketing.
The following are highlights of Community Health's most impressive results:
Hospital admissions grew 8.42% over the prior year, and emergency department volume grew 8.73%.
Unaided top-of-mind awareness increased from 26% in October 2006 to 29% in June 2007.
Preference for Community Health for non-»» life-threatening situations rose from 27% to 30%. Its closest competitor is at 20% preference.
But what's most impressive is that the campaign generated an ROI of 1.06 to 1.
"I think the creative was interesting enough to people—that it was something they didn't expect—so when they saw it, it stood out and it created attention," she says."
Marianne Aiello is an editor with HealthLeaders Media. She may be reached at maiello@hcpro.com.
When Hurricane Gustav blew through Louisiana last August, Mary Ellen Pratt got to say what several other health facility CEOs in the region couldn't.
The new generator serving their new St. James Parish Hospital, a 20-bed critical access facility in the town of Lutcher along the Mississippi River, didn't stop working.
Pratt got the rare opportunity to tell that success story and several others this week to five top Obama Administration officials, including Health and Human Services Secretary Kathleen Sebelius, who conducted what many said was the first rural health tour of its kind.
And many rural healthcare officials believe that the tour, one in a series of trips Washington officials will make to rural settings this summer, and last week's nomination of Regina Benjamin, MD, of Bayou La Batra, signals a new day when rural healthcare is finally getting a front seat at the federal banquet.
As part of the tour Monday, Sebelius, (who is from the largely rural state of Kansas) joined a forum down the road, in the town of Reserve in adjacent St. John the Baptist Parish, with three other administration secretaries: Tom Vilsack of the Department of Agriculture, Hilda Solis of the Department of Labor, and Eric Shinseki of the Department of Veteran's Affairs. Also along was Mary Wakefield, administrator of the Health Resources and Services Administration. They wanted to see and hear first hand the challenges rural providers face.
The officials listened during a 90-minute community forum as those in a standing-room-only audience relayed their fears about growing older with no insurance, no money, chronic conditions, and poor access to care.
In turn, the administrators discussed their hope that many of the problems and disadvantages of providing health care in rural settings will be softened if key provisions in health reform proposal can ever be passed.
There should be money for telemedicine installation, so patients would have the benefit of specialists without having to travel long distances.
Hospitals and doctors and clinics should have electronic medical records.
In St. John the Baptist Parish, the Cabinet officials heard that one family practitioner is the only doctor to serve the entire town, and he was said to be 80 years old, Wakefield recalled.
So there will be about $500 million in recovery money to greatly increase the size of the National Health Service Corps to encourage physicians to set up practices in rural towns they otherwise would ignore.
Wakefield, former director of the University of North Dakota's Center for Rural Health, says the tour "reinforced for me the importance of this administration's commitment to rural health."
What the Cabinet officials heard and saw in conversations with the providers is the fragile nature of the rural health care workforce, she says. The need for mental health, dental health and primary care providers became much more real "up close and personal."
Sebelius and Wakefield took a side trip to Pratt's hospital, spoke with several patients and talked about how telemedicine might one day bring specialty services much closer to their patients' bedsides. And Pratt says, they listened to stories from patients about how dedicated nurses sometimes travel to their hospitalized patients' homes to take care of their pets until the patients are discharged.
Pratt says that several years ago, hospital officials decided it would be cheaper to rebuild the facility than to repair and upgrade it. Of the $19.5 million cost, $18 million came from a direct loan from the Department of Agriculture.
"The issues that our hospital faces is typical of any rural community," Pratt says. "But our demographics tend to be more challenging than in urban areas, with higher levels of poverty and lower levels of education. All that leads usually to challenging health care status."
Other issues involve the difficulty in keeping good quality staff, although the newer building has made recruitment far easier than it was before, she said.
But there is fear about what health reform might bring to hospitals such as St. James, Pratt says. "With health reform, there are going to be some radical changes going on. And everyone involved in health care is uncertain about how this is going to affect us," Pratt says.
What she was referring to is the fear that Medicare will slice disproportionate share reimbursements to rural hospitals, money that pays for care for people with no insurance, supplemental funding St. James depends on to provide care. The idea is that a public option would provide coverage that would, in effect replace that. But the disproportionate share money may go away long before the patients have a chance to be enrolled in a public plan, Pratt says.
"I have concerns that the money for uncompensated care will be removed before everyone is in a health insurance product," Pratt says. "There's going to be a time lag between the plan's offering, and when we get folks with no insurance onboard. But how do we handle that in-between stage, and till make sure our hospitals remain whole."
But those are problems, she said, she has confidence that Sebelius and other Cabinet-level officials appreciate, perhaps much more than in previous administrations.
"In prior administrations, there were always lots of cuts to rural health," Pratt says. "There were cuts to the Flex (Medicare Rural Hospital Flexibility Grant) and several other programs that supported rural health efforts.
"And although it was always reinstated, and we didn't actually get cut, it sent a message were not that valuable to that administration. We always felt vulnerable."
As policymakers look to reduce healthcare costs, they might look closely at ways to prevent osteoporosis, the culprit that led to 1 million hospitalizations in 2006, 254,000 of which were because of fractures stemming from the gradual loss of bone, according to a new report released by the federal Agency for Health Research and Quality.
Using statistics from a nationally representative sample of hospital inpatient stays, the Agency for Health Research and Quality found that not only did these patients generate $2.4 billion in costs in 2006, they required longer hospital stays and two-thirds were admitted through the emergency department.
And more than half the patients were more likely to be discharged to a long-term nursing home or rehabilitation center, compared to 16% of all patients requiring hospitalization for any reason. Fractures can be slow to heal, cause debilitating pain, disability, deformities, and, sometimes, death.
Because most such patients are at least age 65, Medicare paid 87.4% of the bill, according to the report.
"An estimated 10 million people in the U.S. had osteoporosis in 2006," wrote Allison Russo, Laurel Holmquist, and Anne Elixhauser from the AHRQ.
"Despite its prevalence and impact, osteoporosis is both a preventable and treatable condition. Vitamin D, a diet high in calcium, regular exercise and access to bone mineral density screenings and medical treatment can prevent, improve and slow the progression of the condition," they wrote.
However, they continued, "barriers to care, such as variations and limitations in provider coverage of screening tests, could inhibit early detection and treatment, creating a substantial strain on the U.S. healthcare system as the population ages."
A chart accompanying their report shows the steady rise in the rate of hospitalizations where osteoporosis was coupled with an injury. In 1995, there were 55 stays per 100,000 people; in 1999, there were 70; in 2004, 81; and in 2006, 85.
Pathological fractures were the most common osteoporotic injury, followed by hip fractures, fractures of the vertebrae, ribs and pelvis, superficial injuries and contusions, and lastly leg and arm fractures.
Females in all age brackets are affected more than males. Over age 65, five times more women were hospitalized with injurious osteoporosis than men.
One apparent mystery, however, is the wide variation in what part of the country these hospitalizations occur. The Midwest had the highest rate, with 107 per 100,000 people, followed by the Northeast, with 87. Rates in the South and West were considerably lower, with 81 and 68 stays per 100,000 people.
Why people in the Midwest were so disproportionately affected is unclear.
In terms of cost, hip fractures were the most expensive, costing an average of $12,100 each, and required the longest hospital stays (5.7 days).
Nurse salaries are climbing considerably across the nation, according to recently released employer survey data.
The 2009 Compensation Data Healthcare results compiled by Compdata Surveys show wages for RNs increased by 9.2% over the last three years—which translates to an average of $61,300 per year. Previous year-to-year salary increases for nurses have been between $2,000 and $3,000.
Researchers gathered the data among more than 320,000 nurses from nearly 900 healthcare organizations across the U.S. through questionnaires. These included hospitals, long-term care and rehabilitation facilities, homecare agencies, and physician clinics. Results shows nurses on the coasts of the country have the highest salaries; nurses in the Western region will take in an average $75,300 in 2009; and those in the Northeast will make about $67,400.
The findings illustrate the healthcare industry has yearly pay increase budgets running around 3%, while other businesses have pay increases around 2%. The average nursing salary jumped up by 5.3% from 2008 to 2009 alone.
"Many of the positions within the healthcare industry continue to be in high demand and nursing positions continue to lead the pack," says Lane Odle, product marketing manager at Compdata Surveys. "The position's yearly increase of 5.3% is indicative of that."
And, based on the survey data, it appears that nurses' pockets will continue to grow.
"At this time, there is no indication that pay increases for nurses will slow down," says Odle, adding that the consistent, annual salary gains suggest nurses' pay will continue to rise. "Also, HR professionals in the industry are projecting the same pay increase budget for 2010, which means they expect the industry to be stable in the coming year."
Compdata Surveys has yet to set estimates for how much nurse' salaries will increase next year, but Odle anticipates the aging population with further drive them up.
"The Baby Boomers in the [nursing] field are nearing retirement, which will leave a number of vacant positions," she says. "Additionally, longer average life spans are expected to cause the number of individuals seeking medical care to increase exponentially. These factors will increase the demand for healthcare workers."
The healthcare industry is slow to embrace any kind of operational change and tends to be ambivalent about many marketing functions. That's why I was bowled over by the fact that a whopping 88% of senior healthcare executives in a recent HealthLeaders Media study said that patient experience is among their top five priorities—and the number jumped even higher when we asked them about their priorities five years from now.
In the 2009 HealthLeaders Media Industry Survey, conducted late last year, 25% of CEOs put "consumer satisfaction" among their top three priorities in the next three years. They were indifferent about consumer-driven healthcare—the majority (51%) said it would have a neutral impact on their organization in the next three years. Transparency? Only 2% of CEOs said making price and quality data available to consumers was one of their top three priorities.
But this new survey suggests that CEOs are rethinking the importance of improving the patient experience and other studies show that consumerism in healthcare—long talked about—might really be coming after all.
Hospitals have been redesigning rooms, adding amenities, and even improving their menus for a while now. But the focus on patient experience and consumerism must move from cosmetic to strategic.
Consider, for example, a recent survey of 800 Massachusetts adults. Only 24% said they trust their doctor completely to make the right decisions about where they should go to receive medical care. And in the survey, conducted by Boston-based brand communications firm PARTNERS+simons, nearly all respondents (98%) agreed that not all hospitals deliver the same quality of care.
Another survey of 500 healthcare consumers, conducted by Dayton, OH-based NCR, which makes self-service products for hospitals, found many consumers are looking for a more convenient experience. More than half (54%) said they want to be able to book appointments and receive lab results online, for example.
"Today's patients have greater choice—and they are choosing to stay loyal to those healthcare providers that provide the best overall patient experience," the survey report concludes.
Finally (just in case you aren't yet convinced), a 2009 survey of healthcare consumers found still more evidence of a rise in consumerism. In that survey, respondents said they want more information to help them make decisions about where to go for care.
"Consumers want better performance from their healthcare system," writes Paul Keckley, executive director of the Deloitte Center for Health Solutions in Washington, DC, which conducted the survey. "They think it is wasteful, inefficient, complex, and expensive. They are frustrated with the tools useful to them in making decisions about their health are not readily available … They want better value for the dollars they spend and believe fundamental changes are necessary to achieve those goals."
It's pretty hard to ignore those kinds of numbers. True, not everyone is looking up quality and price data online or demanding a better experience when they visit the hospital. But if you're still feeling skeptical about patient experience, indifferent about consumer-driven healthcare, and neutral about transparency, it might be time to catch up with the rest of the healthcare industry—and get in step with patients themselves.
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Health insurers that are anxiously waiting for healthcare reform to shake out before moving forward may find themselves well behind their competitors.
It's understandable that health insurance companies don't want to invest in big-dollar projects without knowing how the industry is going to change. One example is in the area of underwriting. If healthcare reform implements an individual mandate coupled with health insurers accepting all members—regardless of pre-existing conditions—the underwriting process that has become the health insurance industry's foundation will evaporate.
Investing in that area doesn't make sense now, but Dan Maynard, president and CEO of Connecture, says health plans need to use "flexible technology solutions" to prepare for the future. Health insurers shouldn't stay transfixed on the horizon. A more pressing need for insurers is how to stay ahead despite the destruction of the employer-based health insurance market, most notably the small group market. As more Americans are bounced from employer-based health insurance, they are flooding the individual health insurance market. While insurers realize that the individual insurance market is their present and future, many are struggling with how to prevent losses.
In order to survive healthcare reform and the decimated employer-based market, Maynard suggests a combination of technology and marketing, which he says will play a much larger role in the near future. That's because the combination of an eroding employer-based health insurance market coupled with healthcare reform will force insurers to compete for members, which is commonplace in other industries.
What does the future of health insurance marketing entail? Think car and life insurance. Television shows feature ads from Geico, Progressive, and Aflac. Health insurers also may soon become a staple of television and will need marketing departments that understand what consumers want. Technology, meanwhile, will allow insurers to reach out to both members and prospective members through interactive Web sites.
The technology/marketing push will help insurers develop new products, perform lead management, quote rates to consumers, improve enrollment, and retain members. Maynard says health insurers' future is in these four areas:
Easy and flexible product configuration
Multiple avenues for targeted outreach
Real-time and user-friendly online enrollment
Using analytics to understand what attracts and retains a carrier's targeted market
In the near future, health insurers will need to create a platform that will allow insurers to promote products across various market segments. This technology will include a single location for prospective and current members to learn about product information and availability.
"It's one thing to have a marketing site, it's another thing to be targeting different types of consumers and providing different targeted campaigns around your quoting and your lead gen activities," says Maynard. "Health plans are a long ways away from that kind of technology-supported targeted marketing on the Web or otherwise."
Of course, people don't consume information the same way. This means health insurers will need to create outreach across multiple avenues. While young adults appreciate Web communication through fast processes, senior populations may need additional considerations, including a user interface that is compatible with screen-reading applications and flexibility in font size and site view. Seniors could also need additional support through phone calls or even face-to-face communication.
Fewer people with employer-based insurance means health insurers will need to invest in direct-to-consumer offerings as well as interactive Web sites, call centers, and maybe even retail stores.
Having fewer underwriting possibilities, insurers will benefit by creating Web sites that allow for faster enrollment processes. Maynard says insurers also will need to create real-time underwriting processes that allow customers to enroll immediately while allowing the health plans to use the information to design wellness programs tailored to the individual.
Finally, Maynard advises health insurers to use analytics. This may seem like common sense, but most health insurers don't use analytics and those that do are not doing enough. Maynard says insurers need to make sure their Web sites are reaching all people. Health insurance companies can check this by measuring the site's performance, collecting customer experience data, analyzing the most impactful pages, and determining which marketing campaigns are most effective. With this information, insurers can find out where they are losing out on potential sales, he says.
Implementing these changes will be difficult (and costly) for insurers. The health insurance industry is "very immature" when it comes to such targeted marketing capabilities—unlike the financial sector and other insurances, says Maynard. But those who are focusing their energies solely on what's happening (or not happening) in Washington are making a mistake. The loss of the employer-based system is a potentially devastating problem that is now before health insurers—and that momentum is not coming from Pennsylvania Avenue. It's coming from Main Street.
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The House Energy and Commerce Committee—the only panel that has not completed mark-up of the House Tri-Committee healthcare reform bill (H.R. 3200)—cancelled Tuesday's session while members, including seven self-described fiscally conservative "Blue Dog" Democrats, paid a visit down Pennsylvania Avenue to the White House.
The committee, which has faced heated debate in recent days over the reform legislation, ended up cancelling Wednesday's session as well as it works out rough spots in getting legislation passed.
President Obama, trying to gather support for the healthcare reform package, met for several hours with the Democrats on Tuesday. According to one of the members of the Blue Dog group, Rep. Mike Ross (D-AR), the group arrived with 10 demands and spent most of the time focusing on two priorities—producing a deficit neutral measure and containing costs, especially Medicare and Medicaid costs.
One issue considered was the creation of a government advisory panel operating at the federal level to help set Medicare reimbursement rates. On Friday, White House Office of Management and Budget Director Peter Orszag wrote a letter to House Speaker Nancy Pelosi (D-CA) suggesting that the House and its health committees consider either expanding the power of the Medicare Payment Advisory Committee (MedPAC) or creating an entirely new group called the Independent Medicare Advisory Council (IMAC).
In one approach, introduced by Sen. Jay Rockefeller (D-WV), MedPAC—renamed the Medicare Payment and Access Commission— would be given new powers, such as determining payment rates for physicians and hospitals. An IMAC would have the authority to make recommendations to the president on annual Medicare payment rates, as well as other reforms. Either group would be made up of both public and private individuals.
Other issues the Blue Dog group have focused on in terms of health legislation are getting more value from healthcare dollars, implementing delivery reforms to bend the cost curve, and helping individuals, families, and small businesses purchase healthcare coverage.
Obama is said to be still keeping pressure on Congress to vote for healthcare legislation before the lawmakers go home for the August recess. The president has scheduled a news conference at 8 p.m. EDT today that is expected to focus on healthcare reform.
In hopes that it may lead to reduced payment hassles and could save doctors time and money, the American Medical Association yesterday scored seven large health plans plus Medicare in their promptness and accuracy for paying claims.
The survey found a wide variation in practices among the payers, with each using a different set of rules, different timelines, and confusing and inconsistent processes.
The doctors group also listed numerous recommendations for improving the system that would "professionalize transactions, modernize procedures and clarify what is now a real murky mess," said William Dolan, MD, a member of the AMA board of trustees as he released the survey's results.
"Physicians are now bogged down in paperwork," which requires they divert as much as 14% of their gross revenue to assure accurate payments, Dolan said in a Webcast to release the new survey. Ideally, he added, the AMA wants to reduce physician expenditures on such processes to only 1% of their revenue.
"This would reduce angst, and let me tell you there's a lot of it in the healthcare industry, and return the focus to patient care," Dolan said.
Currently, doctors spend a total of three weeks a year, sometimes as much as 35 minutes a day, muddling through, trying to figure out what codes to use and what insurance plans will cover, at a cost of $200 billion a year, he said.
This release of the AMA scorecard is the group's second in a campaign that began last year to put pressure on health plans and Medicare to streamline and standardize their divergent systems into one.
In the report, the AMA compared Aetna, Anthem Blue Cross Blue Shield, Cigna, Coventry, Health Net, Humana, UnitedHealthcare, and Medicare in 18 measures from various points in 2008 and 2009.
Ideally, the AMA wants all claims processes to be simplified so that physicians don't have to work through a confusing array of procedures and rules that take time away from their patients. It also would make it easier for physicians to avoid mistakes when they request reimbursement for care.
"In simplest terms, this campaign would eliminate waste by getting things right the first time," said Dolan, an orthopedic surgeon at the University of Rochester.
Some portion of the solution, the doctors' group said, is mentioned in the so-called Tri-Committee health reform proposal emerging in the House. They hope it will be carried forward in any reconciled legislation that emerges.
Most health plans showed improvement
For physicians, one of the most vexing parts of the claims process is how well insurance plans and Medicare pay the rates as stated in their negotiated contracts. Five of seven health plans significantly improved on this score over 2008 by between 11 and 17 points.
For example, Cigna improved in this category from 66% to 83% while Humana improved from 84% to 93%. Coventry, however, went from 86.7% to 71.9% and HealthNet did not disclose the information. Medicare payments were the most closely aligned, with about 97.5% accuracy.
Another issue is the wide variation in how health payers deny claims.
"The inconsistency found among health insurers in 2008 continues to be demonstrated in 2009," the AMA said in a statement. "The wide variation in how often health insurers deny claims, and the reasons used to explain the denials, indicates a serious lack of standardization in the health insurance industry."
The survey was compiled through a sampling of the National Healthcare Exchange Services (NHES) database, which includes more than 2.5 million services billed within 1.6 million claims from physicians in 62 specialties and 200 practices in 29 states.
Compounding the problem with denials is that in many cases, the claims were correctly denied because the patient did not have coverage for a specific service in their plan. Eligibility continues to be the largest reason for denial, the survey results indicated.
"We need to improve the mechanics of answering the most basic of questions: Is the patient covered by a health insurance plan and (which) is it?" said Mark Rieger, NHES chief executive officer.
All of the records surveyed were taken from practices with electronic records systems. Rieger said the scores would probably be much lower if records from practices that had not yet adopted electronic databases had been reviewed.
Other process measures evaluated in the report card include whether physicians can accurately tell how long each plan will take to reimburse a claim or the amount of time before the physician receives the first check, and whether the plan clearly discloses pre-authorization policies and procedures online.
Another variable scored is how often health plans "claim edit," a process by which plans try to bundle separate billings under one category, which may reduce the amount the physician receives despite the number of times the patient was seen or the amount of care given.
At least four plans and Medicare were asked for comment on the report card.
"We value the AMA's report card on our performance as a way to help us improve how we work with the physician community…and have discussed the report card with the AMA throughout the year to identify improvements," Cigna spokeswoman Amy Turkington replied in an e-mail.
Such changes include revising its communication procedures, "so the information we already provide through our paper explanation of payment will be available on the electronic remittance as well," she wrote.
An individual mandate is among the most far-reaching changes envisioned this year by those pushing for healthcare reform. And it is one of the few common threads running through all three bills being considered in Congress, greatly increasing the likelihood it will survive the legislative process. Just as drivers must purchase auto insurance, the medical system of the future would put responsibility for health coverage first and foremost on every adult.
Current healthcare reform bills under consideration would expand the number of insured, but 90% of voters already have insurance. Congressional leaders say the bills would cut costs, but experts point out that covering the uninsured would cost billions. So the New York Times notes that the typical person watching is left wondering: What will this project mean for me, besides possibly higher taxes?
